Predicting length of stay in head and neck patients who undergo free flap reconstruction

Michael M Lindeborg; Rosh K V Sethi; Sidharth V Puram; Anuraag Parikh; Bharat Yarlagadda; Mark Varvares; Kevin Emerick; Derrick Lin; Marlene L Durand; Daniel G Deschler

doi:10.1002/lio2.410

Predicting length of stay in head and neck patients who undergo free flap reconstruction

Laryngoscope Investig Otolaryngol. 2020 May 28;5(3):461-467. doi: 10.1002/lio2.410. eCollection 2020 Jun.

Authors

Michael M Lindeborg^{1

2}, Rosh K V Sethi³, Sidharth V Puram⁴, Anuraag Parikh^{1

2}, Bharat Yarlagadda^{1

2}, Mark Varvares^{1

2}, Kevin Emerick^{1

2}, Derrick Lin^{1

2}, Marlene L Durand^{1

2

5}, Daniel G Deschler^{1

2}

Affiliations

¹ Department of Otolaryngology Massachusetts Eye and Ear Infirmary Boston Massachusetts USA.
² Department of Otolaryngology Harvard Medical School Boston Massachusetts USA.
³ Department of Otolaryngology University of Michigan Ann Arbor Michigan USA.
⁴ Department of Otolaryngology Washington University School of Medicine in Saint Louis Saint Louis Missouri USA.
⁵ Department of Medicine Massachusetts General Hospital Boston Massachusetts USA.

Abstract

Objective: Understanding factors that affect postoperative length of stay (LOS) may improve patient recovery, hasten postoperative discharge, and minimize institutional costs. This study sought to (a) describe LOS among head and neck patients undergoing free flap reconstruction and (b) identify factors that predict increased LOS.

Methods: A retrospective cohort was performed of 282 head and neck patients with free flap reconstruction for oncologic resection between 2011 and 2013 at a tertiary academic medical center. Patient demographics, tumor characteristics, and surgical and infectious complications were characterized. Multivariable regression identified predictors of increased LOS.

Results: A total of 282 patients were included. Mean age was 64.7 years (SD = 12.2) and 40% were female. Most tumors were located in the oral cavity (53.9% of patients), and most patients underwent radial forearm free flap (RFFF) reconstruction (RFFF-73.8%, anterolateral thigh flap-11.3%, and fibula free flap-14.9%). Intraoperative complications were rare. The most common postoperative complications included nonwound infection (pneumonia [PNA] or urinary tract infection [UTI]) (15.6%) and wound breakdown/fistula (15.2%). Mean and median LOS were 13 days (SD = 7.7) and 10 days (interquartile range = 7), respectively. Statistically significant predictors of increased LOS included flap take back (Beta coefficient [C] = +4.26, P < .0001), in-hospital PNA or UTI (C = +2.52, P = .037), wound breakdown or fistula (C = +5.0, P < .0001), surgical site infection (C = +3.54, P = .017), and prior radiation therapy (C = +2.59, P = .004).

Conclusion: Several perioperative factors are associated with increased LOS. These findings may help with perioperative planning, including the need for vigilant wound care, optimization of antibiotics prophylaxis, and institution-level protocols for postoperative care and disposition of free flap patients.

Level of evidence: 2b; retrospective cohort.

Keywords: anterolateral thigh flap; fibula free flap; free flap; head and neck cancer; head and neck reconstruction; length of stay; radial forearm free flap.